Evidence-based fact checking for selective procedures in restorative dentistry.

OBJECTIVES: Similar to other dental specialties, there are many clinical procedures in restorative dentistry that may or may not be supported by good evidence. Thus, the effectiveness of these procedures is uncertain. The aim of this paper is to reduce this knowledge gap by critically inspecting selective procedures in restorative dentistry and exploring if these well-established or widely advocated treatment modalities are necessary for improving treatment outcomes based on the best available evidence. MATERIALS AND METHODS: A MEDLINE search was conducted to identify research on selective procedures while focusing on clinical trials and systematic reviews. Due to their practical relevance in the decision-making process, cost-effectiveness analyses were also included. RESULTS: Mixed results were identified regarding the included interventions. Some procedures had adequate evidence supporting them while others were mostly based on beliefs. CONCLUSIONS: A critical review of the available literature indicates that some common restorative procedures lack adequate support from high-quality research evidence. CLINICAL RELEVANCE: This paper attempts to highlight the need to critically examine the scientific validity of traditional knowledge and techniques through the context of current research evidence. This will not only help generate consensus between educators, clinicians, and researchers regarding restorative procedures but will also lead to improved patient care and outcomes.

Effect of an additional bonding resin on the 5-year performance of a universal adhesive: a randomized clinical trial.

OBJECTIVES: To evaluate the effect of the application of an additional hydrophobic bonding resin on the clinical performance of a universal adhesive applied in etch-and-rinse (ER) or self-etch adhesive (SE) strategy in non-carious cervical lesions (NCCLs) after 5 years. MATERIALS AND METHODS: Scotchbond Universal Adhesive (3M Oral Care) was applied in 134 NCCLs of 39 subjects using different adhesion approaches: 3-step ER (3-ER), 2-step ER (2-ER), 2-step SE (2-SE), and 1-step SE (1-SE). Enamel and dentin were acid etched prior to application of the universal adhesive for the 3-ER and 2-ER groups. An extra layer of a hydrophobic bonding resin was applied for groups 3-ER and 2-SE. All lesions were restored with Filtek Supreme XTE resin composite (3M Oral Care). Restorations were evaluated at baseline and at 5 years using the modified USPHS criteria. Mann-Whitney U and Wilcoxon tests were performed, and the survival rates (retention/fracture) were analyzed using Kaplan-Meier and log-rank tests (p < 0.05). RESULTS: The recall rate was 66.7% at 5 years. The cumulative survival rate was 96.9% for 3-ER, 96.8% for 2-ER, 71.4% for 2-SE, and 81.3% for 1-SE strategies. The log-rank test was statistically significant (p = 0.006). Retention rates were 100% for both ER groups, 75% for 2-SE and 81.3% for 1-SE. At 5 years, 2- and 1-SE approaches showed similar retention rates, but lower than those for 3- and 2-ER. A significant decrease in retention rate was detected for 2-SE (p = 0.007) and 1-SE (p = 0.014) groups between baseline and 5 years. All groups, except 2-ER, showed an increase in marginal discoloration. For this parameter, significant differences were detected between 2-ER and 1-SE (p = 0.004). CONCLUSIONS: The addition of a hydrophobic bonding resin to the recommended application sequence of Scotchbond Universal Adhesive did not improve its clinical performance in NCCLs after 5 years. Higher retention rates were measured when this adhesive was applied in ER mode. TRIAL REGISTRATION: This manuscript is a 5-year follow-up of a randomized clinical trial that started in 2012 when there was no strong recommendation for registration in clinicaltrials.gov. The results after 36 months of clinical service were previously published in this journal.

A critical analysis of research methods and experimental models to study the load capacity and clinical behaviour of the root filled teeth.

The prognosis of root-filled teeth depends not only on a successful root canal treatment but also on the restorative prognosis. This critical review discusses the advantages and limitations of various methodologies used to assess the load capacity or clinical survivability of root-filled teeth and restorations. These methods include static loading, cyclic loading, finite element analysis and randomized clinical trials. In vitro research is valuable for preclinical screening of new dental materials or restorative modalities. It also can assist investigators or industry to decide whether further clinical trials are justified. It is important that these models present high precision and accuracy, be reproducible, and present adequate outcomes. Although in vitro models can reduce confounding by controlling important variables, the lack of clinical validation (accuracy) is a downside that has not been properly addressed. Most importantly, many in vitro studies did not explore the mechanisms of failure and their results are limited to rank different materials or treatment modalities according to the maximum load capacity. An extensive number of randomized clinical trials have also been published in the last years. These trials have provided valuable insight on the survivability of the root-filled tooth answering numerous clinical questions. However, trials can also be affected by the selected outcome and by intrinsic and extrinsic biases. For example, selection bias, loss to follow-up and confounding. In the clinical scenario, hypothesis-based studies are preferred over observational and retrospective studies. It is recommended that hypothesis-based studies minimize error and bias during the design phase.

Adhesive dentistry: Current concepts and clinical considerations.

OBJECTIVES: To address contemporary concepts in adhesive dental materials with emphasis on the evidence behind their clinical use. OVERVIEW: Adhesive dentistry has undergone major transformations within the last 20 years. New dental adhesives and composite resins have been launched with special focus on their user-friendliness by reducing the number of components and/or clinical steps. The latest examples are universal adhesives and universal composite resins. While clinicians prefer multipurpose materials with shorter application times, the simplification of clinical procedures does not always result in the best clinical outcomes. This review summarizes the current evidence on adhesive restorative materials with focus on universal adhesives and universal composite resins. CONCLUSIONS: (a) Although the clinical behavior of universal adhesives has exceeded expectations, dentists still need to etch enamel to achieve durable restorations; (b) there is no clinical evidence to back some of the popular adjunct techniques used with dental adhesives, including glutaraldehyde-based desensitizers and matrix metalloproteinase inhibitors; and (c) the color adaptation potential of new universal composite resins has simplified their clinical application by combining multiple shades without using different translucencies of the same shade. CLINICAL SIGNIFICANCE: New adhesive restorative materials are easier to use than their predecessors, while providing excellent clinical outcomes without compromising the esthetic quality of the restorations.

Effect of a hydrophobic bonding resin on the 36-month performance of a universal adhesive-a randomized clinical trial.

OBJECTIVES: To evaluate if the addition of a layer of a hydrophobic bonding resin to the recommended application sequence of a universal adhesive improves the respective clinical behavior in non-carious cervical lesions (NCCLs) after 36 months. MATERIALS AND METHODS: Scotchbond Universal Adhesive (SBU, 3M Oral Care) was applied in NCCLs of 39 subjects using four adhesion strategies: (1) three-step ER (etch-and-rinse), (2) two-step ER, (3) two-step SE (self-etch), and (4) one-step SE. An extra layer of a hydrophobic bonding resin was applied for strategies three-step ER and two-step SE. The same composite resin (Filtek Supreme XTE, 3M Oral Care) was used for all strategies. Restorations were evaluated at baseline and 18 and 36 months using the modified United States Public Health Service (USPHS) criteria. Kruskal-Wallis, Mann-Whitney U, Friedman, and Wilcoxon non-parametric tests were computed. RESULTS: The cumulative failure rate was 8.6%. The 36-month retention rates were 100% for both 3-ER and 2-ER, 76.0% for 2-SE, and 86.2% for 1-SE. A lower retention rate was observed for two-step SE at 36 months compared with both three-ER (p < 0.01) and two-ER (p < 0.01). Identical retention rates were measured for the two SE groups. When retention rate was compared at baseline versus 36 months for each adhesion strategy, a significant decrease was observed for 2-SE. The restorations performed with 3-ER, 2-SE, and 1-SE had a significant deterioration in marginal discoloration at the 18-month recall. CONCLUSIONS: The 36-month clinical performance of Scotchbond Universal Adhesive improved for both etch-and-rinse strategies. CLINICAL RELEVANCE: Phosphoric acid etching is still recommended to provide retention to composite restorations in NCCLs.

Resin infiltration of enamel white spot lesions: An ultramorphological analysis.

OBJECTIVE: There is not a clear understanding of the ultramorphology of enamel white spot lesions (WSLs). The purpose of this study is to characterize resin infiltration of enamel WSLs using electron microscopy. MATERIALS AND METHODS: Enamel sections with sound enamel and WSLs were sectioned from extracted teeth and assigned to three groups: (a) left untreated; (b) etched with 15% hydrochloric acid (Icon-Etch); (c) restored with the resin infiltration sequence (Icon-Etch, Icon-Dry, and Icon-Infiltrant). Restored specimens were demineralized to obtain replicas. Observations were carried out under a field-emission scanning electron microscope. RESULTS: Icon-Etch resulted in an array of pits and funneled holes on the WSL. Replicas of WSLs depicted 0.5-6.0-µm-thick shaggy resin tags up to a depth of 465 µm. Enamel crystallites were enveloped with resin at the bottom of the WSL forming a hybrid layer. CONCLUSIONS: The resin infiltrant filled the spaces between the crystallites and resulted in an enamel hybrid layer. CLINICAL SIGNIFICANCE: In addition to masking enamel WSLs, resin infiltration is able envelop residual enamel crystallites forming an enamel hybrid layer. This hybridization makes resin-embedded enamel more resistant to acid attack than sound enamel.

Repair bond strength and nanoleakage of artificially aged CAD-CAM composite resin.

STATEMENT OF PROBLEM: The polymerization of computer-aided design and computer-aided manufacturing (CAD-CAM) composite resins during their manufacture enhances their physical properties and biocompatibility but might compromise their reparability. PURPOSE: The purpose of this in vitro study was to determine the microtensile bond strength and nanoleakage (NL) of aged LAVA Ultimate (LU) CAD-CAM composite resin after different repair protocols. MATERIAL AND METHODS: Fifty-eight LU miniblocks were prepared, thermocycled (10000 cycles, 5°C to 55°C), and assigned to 10 surface pretreatment and bonding protocols: (1) tribochemical silica coating (CoJet, CoJet Sand; 3M ESPE)+Scotchbond Universal Adhesive (SBU; 3M ESPE); (2) CoJet+silane (SI, ESPE Sil; 3M ESPE)+Adper Scotchbond 1 XT Adhesive (XT; 3M ESPE); (3) CoJet+10-methacryloyloxydecyl dihydrogen phosphate-based silane (MO; Monobond Plus; Ivoclar Vivadent AG)+XT; (4) CoJet+XT; (5) 30-µm alumina airborne-particle abrasion (AL)+SBU; (6) AL+SI+XT; (7) AL+MO+XT; (8) AL+XT; (9) no pretreatment+SBU; and (10) no pretreatment+XT. All blocks were repaired using the Filtek Supreme XTE (3M ESPE) composite resin. Stick-shaped specimens (0.9×0.9 mm) were obtained and submitted to microtensile bond strength (µTBS) and %NL testing after 24 hours. µTBS data were analyzed with 1-way ANOVA, followed by the Tukey post hoc test, and NL data with nonparametric Kruskal-Wallis and Dunn tests (α=.05). RESULTS: For µTBS, CoJet, and AL pretreatments showed significantly higher mean µTBS, especially when used together with SBU. No pretreatment+XT yielded the lowest mean µTBS. For NL, marginal sealing improved significantly after the use of SBU regardless of the surface treatment. This improvement was only statistically different after tribochemical silica coating. CONCLUSIONS: Airborne-particle abrasion with alumina particles, silica coated or not, together with the application of SBU resulted in the highest mean µTBS. The lowest %NL was recorded when aged LU blocks were repaired using SBU.

Long-term In Vitro Adhesion of Polyalkenoate-based Adhesives to Dentin.

PURPOSE: To study the influence of a polyalkenoate copolymer (VCP) on the immediate (24 h) and 6-month dentin bonding stability of VCP-based adhesives, using microtensile bond strength (µTBS), nanoleakage (NL), and ultramorphological analyses (FE-SEM). MATERIALS AND METHODS: Eighty-four caries-free molars were randomly assigned to seven adhesives: Clearfil SE Bond (CSE, Kuraray Noritake); Adper Single Bond Plus (SB, 3M ESPE); SB without VCP (SBnoVCP, 3M ESPE); Scotchbond Universal Adhesive applied as a etch-and-rinse adhesive (SBU_ER); SBU without VCP applied as an etch-and-rinse adhesive (SBUnoVCP_ER); SBU applied as a self-etch adhesive (SBU_SE, 3M ESPE); SBU without VCP applied as a self-etch adhesive (SBUnoVCP_SE, 3M ESPE). Half of the beams were tested after 24 h, and the other half was aged in water for 6 months prior to testing. For each tooth/evaluation time, two beams were randomly selected for NL analysis. Statistical analyses of µTBS results were performed using two-way ANOVA, Tukey's post-hoc tests, and Student's t-test for paired data (α = 0.05). Nanoleakage was statistically analyzed using the Kruskal-Wallis and Mann-Whitney tests, with Wilcoxon's test for paired data. For FE-SEM, four caries-free molars were assigned to each of the seven groups. Dentin disks were restored and cross sectioned into halves. One half was observed at 24 h, and the other at 6 months. RESULTS: The highest 6-month mean µTBS was obtained with SBU_SE/SBUnoVCP_SE and SBUnoVCP_ER. SBUnoVCP_SE resulted in greater silver deposition at 6 months. FE-SEM observations showed that CSE and SBU_SE specimens resulted in a submicron hybrid layer without signs of degradation at 6 months. CONCLUSIONS: VCP may contribute to the long-term bonding stability of VCP-based adhesives.

Does Tack Curing Luting Cements Affect the Final Cure?

PURPOSE: Short initial light curing or "tack curing" is used to create a semi-gel state in luting cements for easier excess material cleanup. The effect of tack curing on the final cure of luting cements was measured in terms of hardness. MATERIALS AND METHODS: Three cement types were tested: two dual-curing composite cements (RelyX Unicem 2; Maxcem Elite); three light-curing veneer cements (Choice 2; Variolink Esthetic LC; RelyX Veneer); and two self-curing resin-modified glass-ionomer (RMGI) luting cements (RelyX Luting Plus; Nexus RMGI). Cements were placed in 1.5 × 2 × 8 mm plaster slots covered with orange glass during curing and were cured from one end. Tack curing was performed for 2 to 5 s using an LED curing light, followed 2 min later by 10-40 s final light curing or self-curing, as per manufacturer instructions (n = 10). Control groups received only final light curing or self-curing. After 24 h storage (37°C, 100% humidity), Vickers hardness was measured in 0.5-mm depth increments. Results were analyzed using two-way ANOVA and pairwise comparisons (α = 0.05). RESULTS: The hardness of dual-curing and light-curing cements significantly decreased with increasing depth (p = 0.0001). Tack curing of dual-curing and light-curing cements tended to increase hardness at all depths, except near the surface for light-curing veneer cements. Self-curing cements showed no hardness reduction with depth and no effect from tack curing. CONCLUSION: Although a slight surface hardness reduction may occur in light-curing veneer cements, the overall effect on three luting cement types was insignificant or resulted in only a slight increase in depth-of-cure.

Effect of MDP-containing Silane and Adhesive Used Alone or in Combination on the Long-term Bond Strength and Chemical Interaction with Lithium Disilicate Ceramics.

PURPOSE: To evaluate the effect of a silane and an adhesive containing MDP, used alone or combined in the same solution, on the microshear bond strength (µSBS) to lithium disilicate ceramics immediately and after 1-year water storage, and compare the bond strength results with the Raman spectra of the treated lithium disilicate surfaces. MATERIALS AND METHODS: A total of 30 CAD/CAM blocks of lithium disilicate (LD; IPS e.max CAD) were cut into four square sections (6 x 6 x 6 mm; n = 60 per group) and processed as recommended by the manufacturer. The LD specimens were divided into 12 groups according to the following independent variables: silane coupling agent (no silane; silane without 10-MDP [MBS, Monobond S]; silane with 10-MDP [MB+, Monobond Plus]) and adhesive + luting composite (no adhesive + Enforce; no adhesive + RelyX Ultimate; Prime & Bond Elect [PBE], a silane- and MDP-free universal adhesive + Enforce; Scotchbond Universal Adhesive [SBU], a silane- and MDP-containing universal adhesive + RelyX Ultimate). After each treatment, cylindrical, transparent matrices were filled with a luting composite and light cured. Specimens were stored in water (37°C for 24 h or 1 year) and submitted to the microshear bond strength (µSBS) test. The failure pattern and µSBS were statistically evaluated (α = 0.05). In addition, specimens were examined for chemical interaction using Raman spectroscopy. RESULTS: The use of the adhesive PBE alone showed higher mean µSBS compared with both groups with silane (MSB or MB+) without PBE (p < 0.001) at 24 h. The use of the SBU adhesive or MBS silane alone, as well as MB+ associated with SBU, showed higher mean µSBS (p < 0.001) at 24 h. After 1-year water storage, all groups showed a significant decrease in mean µSBS. However, the application of PBE or SBU associated with MB+ silane showed higher 1-year mean µSBS (p < 0.001). In terms of chemical interaction, when silane (MSB or MB+) was applied, only a slight decrease of Si-O peaks occurred. Otherwise, when PBE or SBU adhesives were applied, methacrylate peaks were only observed in the SBU groups. CONCLUSION: The best results in terms of bond strength after water storage were obtained when an MDP-containing silane was associated with a universal adhesive. The use of a simplified bonding protocol that includes either a silane or a universal adhesive is not recommended.

Chemical Adhesion of Polyalkenoate-based Adhesives to Hydroxyapatite.

PURPOSE: To evaluate the chemical interaction between synthetic hydroxyapatite (HAp) and polyalkenoic acid copolymer- based (also known as Vitrebond copolymer [VCP]) adhesives. MATERIALS AND METHODS: Six dentin adhesive formulations were used: 1) Adper Single Bond Plus (SB); 2) SB formulation without VCP (SBnoVCP); 3) Adper Easy Bond (EB); 4) EB formulation without VCP (EBnoVCP); 5) Scotchbond Universal adhesive (SBU); 6) SBU formulation without VCP (SBUnoVCP). Each adhesive was mixed with HAp, polymerized, and analyzed using FTIR and 13C/31P NMR spectroscopy. RESULTS: The FTIR spectra of SB+HAp indicated that the carbonyl group changed absorption wavenumber compared to that of SBnoVCP+HAp. 13C NMR analysis showed that the presence of methacrylated phosphoric esters in the EB and SBU formulations led to similar carbonyl resonance with or without VCP. 31P NMR revealed a resonance shift at 0.5 ppm for SB+HAp, EB+HAp and SBU+HAp spectra. In comparison with EB+HAp and SBU+HAp, a slight fade-out of the same resonance shift for EBnoVCP+HAp and SBUnoVCP+HAp was observed without completely disappearing, respectively, meaning that VCP might induce a modification of phosphorus moieties in addition to the ionic interaction between phosphate ester groups and HAp. CONCLUSION: Our data suggests that a chemical interaction occurred between VCP-containing adhesives and synthetic HAp.

Laboratory Performance of Universal Adhesive Systems for Luting CAD/CAM Restorative Materials.

PURPOSE: To evaluate the microshear bond strength (µSBS) of several universal adhesive systems applied on five different indirect restorative materials. MATERIALS AND METHODS: Five CAD/CAM materials were selected: 1) indirect resin composite (LAV); 2) feldspathic glass ceramic (VTR); 3) leucite-reinforced glass-ceramic (EMP); 4) lithium disilicate ceramic (EMX); 5) yttrium-stabilized zirconium dioxide (CZI). For each material, 15 blocks were cut into 4 rectangular sections (6 × 6 × 6 mm) (n = 60 per group), and processed as recommended by the respective manufacturer. For each indirect material, the following adhesive systems were applied according to the respective manufacturer's instructions: 1) AdheSE Universal [ADU]; 2) All-Bond Universal (ABU); 3) Ambar Universal (AMB); 4) Clearfil Universal (CFU); 5) Futurabond U (FBU); 6) One Coat 7 Universal (OCU); 7) Peak Universal Bond (PUB); 8) Prime&Bond Elect (PBE); 9) Scotchbond Universal Adhesive (SBU); 10) Xeno Select (XEN, negative control). After the application of the adhesive system, cylinder-shaped transparent matrices were filled with a dual-curing resin cement (NX3) and light cured. Specimens were stored in water (37°C for 24 h) and tested in shear mode at 1.0 mm/min (mSBS). The failure pattern and µSBS were statistically evaluated (a = 0.05). RESULTS: LAV, VTR, and EMP showed a greater number of cohesive fractures than EMX and CZI (p < 0.0001). PUB was the only adhesive for which the mean µSBS reached the highest ranking of statistical significance for all five substrates. When each adhesive was compared across the five substrates, 8 out of 10 (ADU, ABU, AMB, CFU, OCU, PUB, PBE, and SBU) reached the statistically highest mean µSBS when applied on CZI. CONCLUSION: The specific chemical composition of universal adhesives was not the decisive factor in the bond strength values measured for different CAD/CAM indirect materials. There was a wide variability in mean µSBS when different universal adhesives were applied to the several CAD/CAM indirect materials. Most universal adhesives bonded well to air-abraded zirconia.

Randomized clinical trial of four adhesion strategies in posterior restorations-18-month results.

PURPOSE: To evaluate the 18-month clinical performance of four adhesive strategies in posterior composite restorations placed in private practice. MATERIALS AND METHODS: Upon approval by an institutional review board, 144 restorations were inserted in 45 subjects (average age = 32.6) to treat caries lesions or to replace existing restorations in vital molars and premolars. The adhesives OptiBond FL (three-step etch-and-rinse), OptiBond SOLO Plus (two-step etch-and-rinse), OptiBond XTR (two-step self-etch), and OptiBond All-in One (one-step self-etch) were applied as per manufacturer's (Kerr Co.) instructions followed by a nanofilled resin composite (Filtek Z350XT, 3M ESPE) under rubber dam isolation. Restorations were evaluated at baseline and at 18 months using United States Public Health Service (USPHS)-modified criteria and high-resolution digital photographs. Statistical analyses included the McNemar and the Mann-Whitney non-parametric tests (p < 0.05). RESULTS: A total of 137 restorations were evaluated after 18 months. The number of alfa ratings did not change significantly from baseline to 18 months for any of the adhesion strategies. When the 18-month evaluation criteria were pooled by pairs of adhesives, none of the adhesives resulted in a significantly different number of alfa ratings for any of the criteria compared with the other adhesives. CONCLUSION: Bonding strategy did not influence the clinical performance of posterior composite restorations under the clinical conditions used in this study. CLINICAL SIGNIFICANCE: When used in ideal clinical conditions, the composition of current dentin adhesives may be more clinically relevant than their adhesion strategy.

Prefabricated veneers - bond strengths and ultramorphological analyses.

PURPOSE: To measure the microshear bond strengths (µSBS) of composite resin to the intaglio surface of prefabricated indirect veneers and analyze the FE-SEM ultramorphology of the pretreated intaglio surfaces as well as the fracture modes. MATERIALS AND METHODS: Three veneer systems (veneer and respective luting material) were used in this study: two prefabricated veneer types, Cerinate One-hour (CER, DenMat) and Componeer (CMP, Coltene), and a laboratory- made veneer, IPS e.max Press (IPS, Ivoclar Vivadent) used as the control. For each group, 10 veneers were used. After delimitation of the bonding area with a double-faced adhesive tape, 0.8-mm-diameter cylinders of composite luting material were bonded to the pretreated intaglio surface. After polymerization, the specimens were fractured in shear mode using the wire-loop method in a universal testing machine. The pretreated intaglio surface of two extra veneers and four fractured specimens per group were morphologically characterized using FE-SEM. RESULTS: CER resulted in statistically lower mean µSBS (7.1 ± 1.2 MPa) than the other two veneer systems, CMP (15.2 ± 2.5 MPa) and IPS (14.7 ± 1.7 MPa) at p < 0.0001. As seen with the FE-SEM, the intaglio surface of CMP did not display microretentive features, while multiple microretentions were observed in both CER and IPS after HF etching. CONCLUSION: Within the limitations of this in vitro study, the CMP and IPS veneer systems resulted in greater bond strengths than those of the CER veneer system.

Prefabricated composite resin veneers--a clinical review.

OBJECTIVE: This clinical technique article is focused on the use of prefabricated veneers to enhance the esthetic appearance of the anterior dentition in patients who needed an alternative esthetic solution more affordable than traditional porcelain veneers. CLINICAL CONSIDERATIONS: Because prefabricated composite veneer systems have been recently introduced, they are not widely used. The Componeer system (Coltene, Altstätten, Switzerland) contains thin pre-polymerized hybrid composite shells, several shades of a direct hybrid composite resin, an etch-and-rinse adhesive system, and restorative accessories including finishing points and disks. The prefabricated restorations can be customized in the mouth for color and shape. The technique described in this article can be used to restore function and esthetics in one office visit. CONCLUSIONS: The prefabricated composite veneer technique has some of the advantages of direct composite restorations, as only one session is required without the need to take impressions to send to the dental laboratory. This new treatment option may open new opportunities for dental professionals and their patients. However, it is paramount to carry out controlled clinical studies with this restorative technique prior to recommending it without restrictions in general practice. CLINICAL SIGNIFICANCE: The clinical technique described in this paper has the potential for being used routinely to lengthen anterior teeth, to correct malpositioned teeth, to mask discolorations, and to close diastemas. The technique can also be used to restore extensive caries lesions and tooth fractures, and to refurbish large old anterior restorations, especially when other treatment options are out of reach for the patient for financial reasons.

Critical appraisal: post-op sensitivity with direct composite restorations.

Sales of self-etch adhesive systems have grown considerably over the last 10 to 12 years. One of the most important factors contributing to this growth is the perception that self-etch adhesives cause less postoperative sensitivity than etch-and-rinse adhesives. Certainly, there is much anecdotal evidence supporting this perception. But what does the science say? This Critical Appraisal presents evidence from several clinical trials of postoperative sensitivity in posterior composite restorations.

Dentin adhesion and MMPs: a comprehensive review.

This review examines the fundamental processes responsible for the aging mechanisms involved in the degradation of resin-bonded interfaces, as well as some potential approaches to prevent and counteract this degradation. Current research in several research centers aims at increasing the resin-dentin bond durability. The hydrophilic and acidic characteristics of current dentin adhesives have made hybrid layers highly prone to water sorption. This, in turn, causes polymer degradation and results in decreased resin-dentin bond strength over time. These unstable polymers inside the hybrid layer may result in denuded collagen fibers, which become vulnerable to mechanical and hydrolytical fatigue, as well as degradation by host-derived proteases with collagenolytic activity. These enzymes, such as matrix metalloproteinases and cysteine cathepsins, have a crucial role in the degradation of type I collagen, the organic component of the hybrid layer. This review will also describe several methods that have been recently advocated to silent the activity of these endogenous proteases.

A new universal simplified adhesive: 6-month clinical evaluation.

STATEMENT OF THE PROBLEM: Multimode adhesives, which can be used as etch-and-rinse or as self-etch adhesives, have been recently introduced without clinical data to back their use. PURPOSE OF THE STUDY: To evaluate the 6-month clinical performance of Scotchbond Universal Adhesive (SU; 3M ESPE, St. Paul, MN, USA) in noncarious cervical lesions (NCCLs) using two evaluation criteria. METHODS/MATERIALS: Thirty-nine patients participated in this study. Two hundred restorations were assigned to four groups: SU-TEm: etch-and-rinse + moist dentin; SU-TEd: etch-and-rinse + dry dentin; SU-SEet: selective enamel etching; and SU-SE: self-etch. The composite resin Filtek Supreme Ultra (3M ESPE) was placed incrementally. The restorations were evaluated at baseline and after 6 months using both the World Dental Federation (FDI) and the United States Public Health Service (USPHS) criteria. Statistical analyses were performed with Friedman repeated measures analysis of variance by rank and McNemar test for significance in each pair (α = 0.05). RESULTS: Only four restorations (SU-SE: 3 and SU-TEm: 1) were lost after 6 months (p > 0.05 for either criteria). Marginal discoloration occurred in one restoration in the SU-SE group (p > 0.05 for either criteria). Only 2/200 restorations were scored as bravo for marginal adaptation using the USPHS criteria (one for SU-SE and one for SU-SEet, p > 0.05). However, when using the FDI criteria, the percentage of bravo scores for marginal adaptation at 6 months were 32%, 36%, 42%, and 46% for groups SU-TEm, SU-TEd, SU-SEet, and SU-SE, respectively (p > 0.05). CONCLUSIONS: The clinical behavior of the multimode adhesive does not depend on the bonding strategy at 6 months. The FDI evaluation criteria are more sensitive than the USPHS criteria. CLINICAL SIGNIFICANCE: At 6 months, the clinical behavior of the new multimode adhesive Scotchbond Universal was found to be reliable when used in noncarious cervical lesions and may not depend on the bonding strategy employed.

Glutaraldehyde-based desensitizer does not influence postoperative sensitivity and clinical performance of posterior restorations: A 24-month randomized clinical trial.

OBJECTIVES: To evaluate the influence of a glutaraldehyde-based desensitizer (GL) on postoperative sensitivity (POS) in posterior bulk-fill resin composite restorations using an adhesive applied in the self-etch (SE) and etch-and-rinse (ER) strategies; and to assess the clinical performance of the restorations. METHODS: Posterior resin composite restorations (n = 228) at least 3 mm deep were inserted in 57 subjects using a split-mouth design. The adhesive was applied with/without prior application of a GL. A resin composite was used for all restorations. Spontaneous POS (risk and intensity), as well as POS caused by stimulation with an air blast and assess the response to horizontal and vertical percussion was assessed using two scales in the baseline and after 7, 14, and 30 days. In addition, some parameters were evaluated using FDI criteria up to 24 months of clinical service. RESULTS: No significant POS was observed (p > 0.05). A higher absolute risk and intensity of spontaneous POS was observed within 7 days (35.1%), without statistically significant differences among groups. At 24 months 5 restorations were considered clinically unsatisfactory, and 73 restorations showed minor discrepancies in adaptation, with no significant differences between groups (p > 0.05). SIGNIFICANCE: A GL agent does not influence POS in posterior restorations with bulk-fill resin composite. It may be considered a dispensable clinical step in the restorative protocol.